Provider Demographics
NPI:1912553611
Name:FULLILOVE, TERRANCE EUGENE
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:EUGENE
Last Name:FULLILOVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 INMAN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1925
Mailing Address - Country:US
Mailing Address - Phone:216-820-0503
Mailing Address - Fax:
Practice Address - Street 1:910 INMAN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1925
Practice Address - Country:US
Practice Address - Phone:216-820-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health